Dissertation (MSc Public Health)In Tanzania the health insurance started as Community Health Fund (CHF) and was introduced as part of the Ministry of Healths (MoH) attempt to make health care affordable and available to the rural population and the informal sector. This scheme started in 1996 with Igunga as a pilot district and later expanded to other districts (Mtei & Mulligan, 2007). The objective of the study was to assess health systems responsiveness and associated clients/patients satisfaction among users and non-users of health insurance in Dodoma region. Hospital-based analytical cross-sectional study that was conducted between June and July 2018 in different 08 health facilities at OPD in Dodoma. (N=406) client/patients were recruited by convenient sampling at OPDs and interrogated by using an interview self-administered questionnaire. Data were analyzed through SPSS (V26.0) to develop descriptive statistics and logistic regression. Graphs and tables used to present the results of the analysis. The total number of respondents were (n= 406) from the 5 Districts of Dodoma Region purposively selected. Majority of respondents 137(33.7%) were from Dodoma referral Hospital, Bahi district Hospital 69(17.0%), Chemba 73(18.0%), Chamwino were 63(15.5%) and Kongwa 64(15.8%). This study revile that majority 308(75.9%) of respondents who visited hospital had health insurance, while 98(24.1%) had no health insurance. Health systems responsiveness have shown 235(58%) perceived positive, 74(18%) perceived negative while 97(24%) ware neutral. Among the seven domains of responsiveness it is only dignity which signifies the real influence of health insurance usage by 48% more (OR 0.48, P-Value 0.002) with (AOR 0.563, P-Value 0.027). From focus level the two categories of satisfaction with hospital hours by clients/patients and leaving hospital without extra charges have shown influence on the use of health insurance by (X2- 0.015, P-Value 0.018) and (X2- 0.001, P-Value 0.002) respectively. When customer/patient are shown friendliness and courtesy (X2- 0.002, P-Value 0.045), patients/customers adhered by medical personnel (X2- 0.020, P- Value 0.033) and enough hospital working hours with (X2- 0.053 and P-Value 0.005). General the overall health insurance awareness with insurance stand at 82.35%, on the other side the awareness without insurance stand at 58.46%. Meanwhile the general awareness for those who are not insured stand at 17.64% while for those without insurance and they are not aware their figure stand at 41.54%. This study has shown significance chances for some of the patterns of satisfactions, responsiveness and awareness from clients/patients towards enrolling in various health insurance schemes. Health insurance agencies need to raise community awareness on health insurance for it has shown great positive significance. The responsiveness with health systems, the aspect of dignity out of seven domains is the only aspect with significances.